Turning Down the Pressure

Even though you can't feel high blood pressure, it's putting you at risk of health problems, including heart attacks, strokes, and kidney failure. Find out why it's so important to treat your high blood pressure, how blood pressure medications work, how to find the treatment that's best for you, and how to make sure your treatment gives you the results you need.

Blood pressure: out of sight, out of mind?

You can't see it, you can't feel it... sometimes it's hard to believe your high blood pressure is really there! But what you can't feel can hurt you.

Here's what high blood pressure can do to your body. Your blood provides valuable oxygen and nutrients to your organs and tissues as it circulates throughout your body. You need a certain amount of blood pressure to make sure that your organs and tissues receive enough blood to keep them healthy. But too much pressure can be a bad thing. Over time, high blood pressure can damage the organs, including the eyes, kidneys, brain, and heart. This can lead to:

stroke

heart attack

heart failure

kidney failure

eye damage

The longer high blood pressure is untreated, the worse the damage can be. And the damage is being done, even if you can't feel it! That's why it's so important to find a treatment that works for you.

There are many ways to lower your blood pressure. Just changing your lifestyle can go a long way. A healthy diet and regular exercise can lower your blood pressure as much as some medications. For some people, lifestyle changes may be enough. Others may need to combine lifestyle changes with medications to bring their blood pressure down to a healthy level.

If making lifestyle changes or taking your medications as prescribed is easier-said-than-done for you, you're not alone. Many people get effective solutions from their doctors to help them stay on track. For instance, if you're taking a number of medications and are having problems remembering to take them all when you should, talk to your doctor about whether there are combination medications available for the ones you take to help lighten your medication load. Remember, you can't get the full benefit from your blood-pressure-lowering medications if you don't take them regularly as prescribed.

When it comes to high blood pressure, the saying "out of sight, out of mind" can be dangerous! Talk to your doctor about ways to bring your blood pressure down to a healthy level.

How does your blood pressure medication work?

Blood pressure medications are grouped into several classes. Each class works in a different way to lower blood pressure. The main classes are:

diuretics (e.g., hydrochlorothiazide, furosemide): This class of medications works by increasing the amount of urine your body produces. This causes the body to lose salt and water, which decreases the volume of the blood, leading to lower blood pressure.

ACE inhibitors (e.g., enalapril, lisinopril, ramipril): This class of medications works by blocking the body's production of a substance that tightens the blood vessels. As a result, the blood vessels become more relaxed, and the pressure of the blood inside the vessels decreases.

beta-blockers (e.g., atenolol, metoprolol, propranolol): These medications work by slowing down the heartbeat and decreasing the strength of each beat. This means blood is pumped through the vessels with less force, which lowers blood pressure.

angiotensin II receptor blockers (e.g., candesartan, losartan, valsartan): This group of medications works in a similar way as the ACE inhibitors. But instead of blocking the production of the blood vessel-tightening substance, it stops the substance from working on the blood vessels. This causes the blood vessels to relax and the blood pressure to decrease.

calcium channel blockers (e.g., diltiazem, nifedipine, verapamil): These medications work by relaxing the tiny muscles that surround the blood vessels as well as decreasing the speed and strength of each heart beat. When these muscles relax, the blood vessels become larger. Larger vessels means more space for the blood inside the vessels and lower blood pressure. Also, the blood is pumped through the vessels with less force, which lowers blood pressure.

There are a number of products available in combination formulations that contain two medications in one pill.

Although not a separate class, there are a number of products available in combination formulations that contain two medications in one pill (e.g., lisinopril plus hydrochlorothiazide (Zestoretic®), enalapril plus hydrocholorthiazide (Vaseretic®), eprosartan plus hydrochlorothiazide (Teveten Plus®), and many others). These combination products reduce the number of pills you need to take.

Understanding how your blood pressure medication works will help you be better informed about your treatment. If you have any questions, ask your doctor or pharmacist.

Which blood pressure treatment is right for you?

There are so many blood pressure treatments to choose from. How do you know which one is right for you?

You and your doctor will work together to find a blood pressure treatment plan that fits your needs and your lifestyle. The recommended approach for most people is to start with a healthy living plan that includes:

a low-salt, healthy diet

moderate alcohol intake

regular physical activity

smoking cessation

These changes have been proven to lower blood pressure.

Some people may also need to add medications to their plan; this depends on your blood pressure. If your blood pressure is quite high, you may need to start a medication right away. If not, your doctor may recommend you try the healthy living plan on its own for a few months to see how much it will reduce your blood pressure. If you can reach a healthy blood pressure using healthy living, you won't need any medication. Otherwise, your doctor may recommend you start a medication.

Starting a medication does not mean you should stop your healthy living plan. These changes can help your medications work better and make you healthier.

Combination medications can help make taking your medications easier.

So which medication is best? The answer depends on your body and medical history, your preferences, and your schedule. Your doctor will consider all of these factors when recommending a medication. Many people will start on a diuretic, alone or in combination with another type of blood pressure medication, such as ACE inhibitors, beta-blockers, or calcium channel blockers. Your doctor may recommend a different medication if you have certain medical conditions, including:

diabetes

chronic kidney disease

heart failure

history of heart attack or stroke

For more information on the different types of medications and how they work, see "How does your blood pressure medication work?"

Not sure if you're on the best medication? Talk to your doctor about your blood pressure treatment plan and whether it's meeting your needs.

less than 140/90 ("140 over 90") for people without diabetes or kidney disease

less than 130/80 ("130 over 80") for people with diabetes or kidney disease

Next, find out your current blood pressure. You can ask your doctor to check it, or ask your pharmacist about choosing a blood pressure monitor so you can measure it at home. Ask your doctor how often you should have your blood pressure tested. It's also a good idea to compare the results you get in your doctor's office to those you get on your home blood pressure monitor, as they may be slightly different.

Then, if your blood pressure is not at your target level, ask your doctor what you can do to get the results you need. If your blood pressure is not at its target level, there may be a few reasons:

You are having trouble following your healthy living plan.

You are having trouble taking your medication as directed.

You need a higher dose of your medication.

You need to change to a new medication.

You need to add another medication to your treatment plan.

Whether you're struggling with your healthy living plan or taking your medication according to schedule, it's important to determine why you're having difficulty controlling your high blood pressure before changing your medication dose or adding another medication you might not need. Be up front with your doctor – they have your best interests and good health at heart.

Here are some tips on sticking to your plan:

Following your healthy living plan: It's not easy to make changes to your lifestyle. Don't expect to be able to change immediately. Focus on small, achievable changes that you can make, and ramp it up over time. Sometimes adding a bit of variety, such as a new form of exercise or a different type of food, can give you the boost you need. And don't forget to reward yourself! If you've had a good week sticking to your plan, arrange a healthy treat such as a trip to the movies (but skip the popcorn).

Taking a combination blood-pressure-lowering medication may save you money.

Taking your medications as directed: There are many reasons why it can be tough to stick to your medication. Choose the tips that apply to your particular concerns:

Having trouble remembering to take it? Ask your doctor or pharmacist whether your medication routine can be simplified. For example, if you're taking more than one medication, you may be able to use a combination product that has two medications in one pill. Your pharmacist can also package your medication in a dosette, a special container with slots for each day so that you can see whether you've taken that day's dose. Or, you can try alarms and reminders. You can set your alarm clock or watch to beep when it's time for your medication. You can even use an online program for medication reminders, which can send you an email, give you a call, or send a text message when it's time to take your medication. Making it part of your daily routine can also help – take it when you brush your teeth, for example.

Have too many pills? Again, ask your doctor or pharmacist how you can simplify your medication routine, such as using combination products that have two medications in one pill (e.g., lisinopril plus hydrochlorothiazide (Zestoretic®), enalapril plus hydrocholorthiazide (Vasoretic®), eprosartan plus hydrochlorothiazide (Teveten Plus® and many others).

Having side effects? Contact your doctor or pharmacist to find out whether the side effects will eventually go away, how they can be managed, and whether there are other medications that may not have these side effects.

Not sure whether it's working? Ask your doctor how often you should have your blood pressure tested. This test will show you how well your medication is working. It's important to realize that some medications take time to work, and your medication will not work properly unless you take it as directed.

Medication too expensive? Check with your doctor or pharmacist about alternatives. You may be able to save money by switching to a combination medication or by choosing a different medication.

Find out today whether you're getting the results you need! And if you're having trouble following your treatment plan, try the tips above or talk to your doctor or pharmacist about ways to make it easier.